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URTI
| Question | Answer |
|---|---|
| Lower respiratory tract infections | pneumonia and bronchitis |
| upper respiratory tract infections | sinusitis, pharyngitis, laryngitis, common cold |
| causes of allergic rhinitis | Allergen exposure -> allergic response (histamine, leukotrienes, prostaglandins) |
| Allergic rhinitis Sxs | at least 1 of: -Rhinorrhea -Nasal congestion -Nasal itching -Sneezing Other S/Sx: -Cough, red/watery eyes, loss of smell, postnasal drip, sore throat, HA |
| TX of intermittent (mild and mod/severe) allergic rhinitis | avoid triggers pharm: oral antihistamines or intranasal antihistamines |
| TX of persistent, mild allergic rhinitis | avoid triggers pharm: intranasal steroids |
| MOA for intranasal steroids | MOA: inhibit early & late inflammatory response |
| ADE for intranasal steroids | ADE: HA, nasopharyngitis, dryness, epistaxis Not expected to cause systemic ADE |
| intranasal steroids | The "Son"s: Budesonide (Rhinocort) OTC Fluticasone (Flonase) OTC Mometasone (Nasonex) OTC Triamcinolone (Nasacort) OTC Beclomethasone (Beconase AQ; Qnasl) Rx Ciclesonide (Omnaris; Zetonna) Rx Flunisolide (Nasalide) Rx |
| Pearls for the intranasal steroids | Best when taken for 2-3 weeks (usually daily or BID) Most effective; best for sneeze , itch, rhinorrhea, CONGESTION, eyes |
| 2nd generation PO antihistamines | Cetirizine (Zyrtec) OTC ->Levocetirizine (Xyzal) Rx Fexofenadine (Allegra) OTC Loratadine (Claritin) OTC -> Desloratadine (Clarinex) Rx |
| MOA for 2nd generation PO antihistamines | MOA: bind H1-receptors-> inhibit histamine release |
| ADE for 2nd generation PO antihistamines | anticholinergic (dry mouth, dry eyes, constipation, urinary retention, constipation, impaired cognition), sedation |
| Pearls for 2nd generation PO antihistamines | Daily > PRN ~150 min to work Less ADE than 1st generation (diphenhydramine (Benadryl)) Best for sneeze, itch, rhinorrhea, eyes |
| intranasal antihistamines | Azelastine (Astepro) OTC Olopatadine (Patanase) Rx |
| MOA for intranasal antihistamines | bind H1-receptors -> inhibit histamine release |
| ADE for intranasal antihistamines | bitter taste, sedation |
| Pearls for intranasal antihistamines | 15 min to work (azelastine) 30 min to work (olopatadine) Usually BID Best for sneeze, itch, rhinorrhea |
| TX of persistent, mod/severe allergic rhinitis | avoid triggers pharm: intranasal steroids +/- intranasal antihistamine |
| What qualifies this pt for ABX: acute otitis media in ped <6 mo | ALWAYS get ABX ASAP |
| What qualifies this pt for ABX: acute otitis media in ped 6-23 mo | ABX IF: severe sx (more than 48 hours, temp ≥ 102.2 in the past 48 hours) otorrhea bilateral otitis media (unilateral lacking otorrhea= wait and watch) |
| What qualifies this pt for ABX: acute otitis media in ped >/= 2 yo | ABX IF: severe sx (more than 48 hours, temp ≥ 102.2 in the past 48 hours) otorrhea (wait and watch if unilateral/bilateral otitis media, mild sx) |
| Tx for a peds pt with acute otitis media with NO ABX exposure w/in 30 days | PO amoxicillin |
| Tx for a peds pt with PURULENT acute otitis media who HAD ABX exposure w/in 30 days, or a hx of unresponsiveness to amoxicillin | PO Augmentin |
| #1 alternative for a ped with acute otitis media with an intolerance to PCN-based ABX | Cephalosporin: PO cefdinir (Omnicef®) PO cefpodoxime (Vantin®) PO cefuroxime (Ceftin®) IM/IV ceftriaxone (Rocephin®) |
| #1 alternative for a ped with acute otitis media with an intolerance to PCN-based ABX OR Beta-lactam ABX | clindamycin, azithromycin, or clarithromycin |
| Tympanostomy tubes | considered for recurrent Acute otitis media [3 episodes in 6 months or 4 in 12 months (with 1 in previous 6 months)] |
| used to tx newly implanted tympanostomy tubes | antibiotic + glucocorticoid: Otovel (ciprofloxacin + fluocinolone acetonide) x 7 days Ciprodex (ciprofloxacin + dexamethasone) x 7 days Ofloxacin: x 10 days |
| difference between Adult and Peds dx for acute otitis media | Adult= No watch and wait-> immediately ABX Kids= can be watch and wait or ABX immediately |
| 1st line tx for ADULT acute otitis media | Augmentin |
| 2nd line tx for ADULT acute otitis media ( if 2st line tx failed) | levofloxacin or moxifloxacin |
| 1st line ALTERNATIVE tx for ADULT acute otitis media | amoxicillin, cefdinir, cefpodoxime, cefuroxime, ceftriaxone |
| TX for ADULT acute otitis media if pt has an anaphylactic beta lactam reaction | doxycycline(preferred), azithromycin, or clarithromycin |
| duration of ABX tx for acute otitis media for < 2 yo OR pt with severe sx | 10 days |
| duration of ABX tx for acute otitis media for 2+ yo | 5-7 days |
| duration of ABX tx for tympanostomy tubes | 7-10 days |
| duration of ABX tx for acute otitis media for adults | 10 days (levofloxacin in 5 days only) |
| time frame in which signs and symptoms of acute otitis media should resolve | 72 hours (if not resolved tx failure should be considered) |
| 1st line tx for otitis externa | Gentle cleansing + One: - ciprofloxacin + steroid -ciprofloxacin 6% (ONE DOSE) -Neomycin + polymyxin + hydrocortisone |
| 2nd line tx for otitis externa | Gentle cleansing + One: -ofloxacin -acetic acid + propylene glycol + hydrocortisone |
| non pharm tx for sinusitis | humidifier warm compress take a hot bath/ shower |
| OTC tx for sinusitis | Analgesics & antipyretics -Acetaminophen -Ibuprofen -Naproxen Saline irritation Decongestants (PO= pseudophedrine) (IN= phenylephrine) |
| MOA of OTC PO and intranasal decongestants | MOA: alpha agonists nasal vasoconstriction |
| ADE of OTC PO and intranasal decongestants | HTN, palpitations, insomnia, HA, irritability, urinary retention Avoid in CVD |
| OTC intranasal decongestants for sinusitis | Oxymetazoline (Afrin) and Phenylephrine (Neo-Synephrine) |
| OTC PO decongestants for sinusitis | Pseudoephedrine (Sudafed) (Federal limits /abuse potential) |
| reason why you can only take OTC intranasal decongestants for sinusitis for a MAX of 3 days | rebound congestion |
| sinusitis is usually self limited and does not need ABX. When would you need to give ABX | Sx > 10 days Severe Sx >3 days (or fever) Double sickening: initial improvement, then gets worse |
| 1st line tx in adults AND peds for sinusitis | Augmentin (preferred) Amoxicillin |
| 2nd line tx in adults w sinusitis | Cefdinir, Cefpodoxime, Cefuroxime -OR- Levofloxacin or Moxifloxacin -OR- Doxycycline |
| 2nd line tx in peds w sinusitis | Clindamycin (only if Strep pneumoniae) -OR- Levofloxacin -OR- 2nd/3rd Gen cephalosporins |
| duration of ABX tx for adult sinusitis | x 5-10 days |
| duration of ABX tx for peds sinusitis | x 10-14 days |
| dx of pharyngitis | rapid streptococcal antigen test= specificity= 95%, sensitive= 70-90% NAAT= + predictive= 97.7%; - predictive= 100% (No need for another) Throat culture= 95% sensitive |
| 1st line tx for bacterial pharyngitis | Penicillin VK (PREFERRED)* (x 10 days) Pen G Amoxicillin (x 10 days) |
| 1st line tx for a pt with bacterial pharyngitis and a minor PCN allergy | all= x10 days Cephalexin Cefadroxil Cefdinir Cefpodoxime |
| 1st line tx for a pt with bacterial pharyngitis and an anaplylactic PCN allergy | Clindamycin (x 10 days) Azithromycin (x 5 days) Clarithromycin (x 10 days) |
| Tx of laryngitis | NO ABX- vocal rest, humidifier, oral anesthetics |
| Tx of common cold | NO ABX- sx relief (analgesics, anesthetics, cough suppression, expectorants, decongestants), non-pharm |
| Tx for acute bronchitis | NO ABX (unless pertussis or high risk pt) symptomatic tx |
| Tx of pertussis | Azithromycin x 5 days (or erythromycin) Alt= TMP/SMX, clarithromycin x 14 days |
| tx of SEVERE and UNCOMPLICATED acute bronchiole exacerbation of chronic bronchitis | Azithromycin * Clarithromycin Cephalosporin (cefuroxime, cefpodoxime, cefdinir) Doxycycline TMP/SMX x5-7 days |
| tx of SEVERE and COMPLICATED acute bronchiole exacerbation of chronic bronchitis | Amoxicillin/clavulanate* Levofloxacin Moxifloxacin x5-7 days |
| acute bronchiole exacerbation of chronic bronchitis complications (makes you use Augmentin instead of azithromycin) | Age >65 FEV1 <50% predicted ≥ 2 exacerbations/year CVD |
Created by:
rew12042000
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